Wartenberg's Sign: Difference between revisions
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Wartenburg’s sign is a test used for assessing integrity of the motor innervations of hand intrinsics in cases of suspected ulnar neuropathy. The inability to perform adducted digital extension is due to weakness in ulnar innervated intrinsic muscles, and the unopposed action of the slightly medially attached extensor digiti minimi results in extension and abduction of the 5th digit.<ref name="Dutton et al">Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.</ref> A positive test indicates ulnar nerve neuropathy but does not determine site of compression (Guyon’s canal, cubital tunnel, arcade of Struthers). | Wartenburg’s sign is a test used for assessing integrity of the motor innervations of hand intrinsics in cases of suspected ulnar neuropathy. The inability to perform adducted digital extension is due to weakness in ulnar innervated intrinsic muscles, and the unopposed action of the slightly medially attached extensor digiti minimi results in extension and abduction of the 5th digit.<ref name="Dutton et al">Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.</ref> A positive test indicates ulnar nerve neuropathy but does not determine site of compression (Guyon’s canal, cubital tunnel, arcade of Struthers). | ||
== Technique<br> == | == Technique<br> == | ||
It is seen that the author (Robert Wartenberg) had not prescribed a specific technique to assess the sign. The literature describes few techniques of assessment based on the explanation given by the author. | It is seen that the author (Robert Wartenberg) had not prescribed a specific technique to assess the sign. The literature describes few techniques of assessment based on the explanation given by the author. | ||
*A study by Goldman et al (2009) <ref name="goldman">Goldman SB, Brininger TL, Schrader JW, Curtis R, Koceja DM. Analysis of clinical motor testing for adult patients with diagnosed ulnar neuropathy at the elbow. Arch Phys Med Rehabil 2009;90:1846-52</ref> adopted the technique to assess Wartenberg's Sign - The patient is placed with wrist in neutral position and forearm fully pronated and instructed to perform full extension of all the fingers. Once digits are extended patient is asked to fully abduct all fingers and then adduct all fingers. A positive sign is indicated with the observation of abduction of the 5th digit, with inability to adduct the 5th finger when extended. | *A study by Goldman et al (2009) <ref name="goldman">Goldman SB, Brininger TL, Schrader JW, Curtis R, Koceja DM. Analysis of clinical motor testing for adult patients with diagnosed ulnar neuropathy at the elbow. Arch Phys Med Rehabil 2009;90:1846-52</ref> adopted the technique to assess Wartenberg's Sign - The patient is placed with wrist in neutral position and forearm fully pronated and instructed to perform full extension of all the fingers. Once digits are extended patient is asked to fully abduct all fingers and then adduct all fingers. A positive sign is indicated with the observation of abduction of the 5th digit, with inability to adduct the 5th finger when extended. | ||
*David J Magee <ref name="Magee">David J. Magee:Orthopedic Physical Assessment: chapter 6-elbow ;sixth edition;Elsevier Health Sciences, 2008</ref> propose another technique with minor variation - The patient sits with his or her hand resting on the table. The examiner passively spreads the finger apart and asks the patient to bring them together again. Inability to squeeze the little finger to the remainder of the hand indicates positive test for ulnar neuropathy. | *David J Magee <ref name="Magee">David J. Magee:Orthopedic Physical Assessment: chapter 6-elbow ;sixth edition;Elsevier Health Sciences, 2008</ref> propose another technique with minor variation - The patient sits with his or her hand resting on the table. The examiner passively spreads the finger apart and asks the patient to bring them together again. Inability to squeeze the little finger to the remainder of the hand indicates positive test for ulnar neuropathy. | ||
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
Revision as of 23:13, 20 December 2014
Definition[edit | edit source]
Wartenberg's Sign refers to the slightly greater abduction of the fifth digit, due to paralysis of the abducting palmar interosseous muscle and unopposed action of the radial innervated extensor muscles (digiti minimi, digitorum communis ).[1]
Background [2] [edit | edit source]
The first literature regarding this sign appears to be the Letter to the Editor By Robert Wartenberg himself at 1939. In this ,he emphasize the diagnostic importance of this sign in ulnar nerve neuropathy which is not documented. The author further describes "this sign consists of position of abduction assumed by the little finger. Sometimes the fourth finger too has a tendency to assume a position of abduction, but usually it is only the little that is found in abnormal position. It was found to be most conspicuous when the patient was asked to extend his finger at the proximal joints. The importance of this sign has become increasingly evident from numerous experiences which indicate that this tendency of the little finger to be abducted may constitute an early (in some cases the first) and also a late sign of ulnar palsy".
"From the physiological standpoint , this sign is easily understandable. Adduction of the little finger is performed by the interosseous and abduction by the hypothenar muscles. Both groups of the muscles are innervated by the ulnar nerve. However, in abduction of the little finger ,the extensor digiti minimi and the branch to the little finger of extensor digitorum communis also play a definite part.These both are innervated by radial nerve. If the muscles innervated by the ulnar nerve are weak, those innervated by the intact radial nerve predominate in strength and abduct the little finger. Thus it is understandable why this abduction of the little finger is best seen when extensor digitorum communis comes into action and extends the fingers and the hand. In cases with the combined palsy of ulnar nerve and radial nerve ,this sign would not be present" explains the author.
Purpose[edit | edit source]
Wartenburg’s sign is a test used for assessing integrity of the motor innervations of hand intrinsics in cases of suspected ulnar neuropathy. The inability to perform adducted digital extension is due to weakness in ulnar innervated intrinsic muscles, and the unopposed action of the slightly medially attached extensor digiti minimi results in extension and abduction of the 5th digit.[3] A positive test indicates ulnar nerve neuropathy but does not determine site of compression (Guyon’s canal, cubital tunnel, arcade of Struthers).
Technique
[edit | edit source]
It is seen that the author (Robert Wartenberg) had not prescribed a specific technique to assess the sign. The literature describes few techniques of assessment based on the explanation given by the author.
- A study by Goldman et al (2009) [4] adopted the technique to assess Wartenberg's Sign - The patient is placed with wrist in neutral position and forearm fully pronated and instructed to perform full extension of all the fingers. Once digits are extended patient is asked to fully abduct all fingers and then adduct all fingers. A positive sign is indicated with the observation of abduction of the 5th digit, with inability to adduct the 5th finger when extended.
- David J Magee [5] propose another technique with minor variation - The patient sits with his or her hand resting on the table. The examiner passively spreads the finger apart and asks the patient to bring them together again. Inability to squeeze the little finger to the remainder of the hand indicates positive test for ulnar neuropathy.
{{#ev:youtube|K7EmeSGqEp4}
Recent Related Research (from Pubmed)[edit | edit source]
References[edit | edit source]
- ↑ A.J. Larner; A Dictionary of Neurological Signs; Springer Science &amp;amp; Business Media, 12-Nov-2010; page 369
- ↑ Robert Wartenberg, M.D ;A SIGN OF ULNAR PALSY ;JAMA. 1939;112(17):1688. doi:10.1001/jama.1939.62800170002011a.
- ↑ Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
- ↑ Goldman SB, Brininger TL, Schrader JW, Curtis R, Koceja DM. Analysis of clinical motor testing for adult patients with diagnosed ulnar neuropathy at the elbow. Arch Phys Med Rehabil 2009;90:1846-52
- ↑ David J. Magee:Orthopedic Physical Assessment: chapter 6-elbow ;sixth edition;Elsevier Health Sciences, 2008
